Individual
MR. DOMINIC JOHN RAYMOND II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
56 MILEGROUND RD, SUITE A, MORGANTOWN, WV 26505-3803
(304) 296-2273
(304) 296-0825
Mailing address
56 MILEGROUND RD, SUITE A, MORGANTOWN, WV 26505-3803
(304) 296-2273
(304) 296-0825
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2703
WV
1223G0001X
General Practice Dentistry
DN 10380
FL
1223G0001X
General Practice Dentistry
DS023559L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0133055000
—
WV
Enumeration date
09/28/2006
Last updated
05/05/2015
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